Garth Thomas Porter, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

8046391-9921 Issued in UT

Practice address

2441 21St St
US Army Dental L Activity
Fort Campbell, KY 42223-5582

Phone

(270) 798-8751

Fax

(270) 956-0266

NPI assigned

Aug 5, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471996800000",
    "number": "1659650828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2441 21ST ST",
            "address_2": "US ARMY DENTAL L ACTIVITY",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235582",
            "telephone_number": "270-798-8751",
            "fax_number": "270-956-0266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2441 21ST ST",
            "address_2": "US ARMY DENTAL L ACTIVITY",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235582",
            "telephone_number": "270-798-8751",
            "fax_number": "270-956-0266"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTER",
        "first_name": "GARTH",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-05",
        "last_updated": "2016-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "8046391-9921",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "UT",
            "license": "8046391-9921",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phelps Frederic Pond Jr., RN, CNS
• Alicia Nichole Ponder, PA-C
• Matthew Nicholas Ponder, MD
• Danielle Annette Pope, LPN
• Kandi Pope
• Gail Post-Pinchek, PSY.D.
• Manuel Pouparina, M.D.
• James Bleak Powell, DDS
• Vladmir Powell, RN
• Jonathan R Poyourow, R.D.

• Oral and Maxillofacial Surgery (Dentist) in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Oral and Maxillofacial Surgery (Dentist) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.